Provider Demographics
NPI:1811266281
Name:GULF COAST REHABILITATIVE SERVICES, INC
Entity type:Organization
Organization Name:GULF COAST REHABILITATIVE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANTOS
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MFT,LCDC, LMFT
Authorized Official - Phone:361-882-1413
Mailing Address - Street 1:4639 CORONA DR STE 15
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5438
Mailing Address - Country:US
Mailing Address - Phone:361-882-1413
Mailing Address - Fax:361-882-1417
Practice Address - Street 1:4639 CORONA DR STE 15
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5438
Practice Address - Country:US
Practice Address - Phone:361-882-1413
Practice Address - Fax:361-882-1417
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GULF COAST REHABILITATIVE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-14
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 101YP2500X, 106H00000X, 261QM1300X
TX34703471324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty